Impacto de la extubación temprana en cirugía cardiaca pediátrica sobre la estancia hospitalaria postoperatoria en la Fundación Cardioinfantil - Instituto de Cardiología de Bogotá

En los 80s se impulsó el concepto de la anestesia fast-track en cirugía cardiaca, en la cual los pacientes son extubados en las primeras 6 horas del postoperatorio, favoreciendo tiempos de estancia más cortos en la UCIP y una menor incidencia de complicaciones. Objetivo: determinar si la extubación en salas de cirugía permite acortar más la duración de la estancia en UCIP. Metodología: estudio de cohorte, prospectivo. Población: niños sometidos a cirugía cardiaca abierta electiva en la FCI entre enero 1 y julio 31 de 2009. El tamaño de la muestra calculado fue de 74 pacientes. Se les hizo seguimiento y se registró la información requerida. Resultados: 37 pacientes ingresaron al grupo de extubación en UCIP (grupo 1), y 37 ingresaron al grupo de extubación en salas (grupo 2). En el grupo 1 la duración de la estancia en la UCIP fue 2.72 +/- 1.63 días y 1.65 +/- 0.86 días en el grupo 2 (p=0.001). El tiempo de estancia en la UCIP se re-categorizó a mayor de 48 horas y menor de 48 horas y se midió el RR crudo y el ajustado con un análisis estratificado de Mantel Haenszel. Al ajustar por categoría de RACHS-1, esta asociación permanece, pero no hubo diferencia estadísticamente significativa. RR combinado (Mantel Haenszel) = 1.27 -IC 95% (0.86 1.86)-. Conclusiones: la extubación en salas, tras cirugía cardiaca pediátrica, no reduce la duración de estancia en UCIP

ECMO veno-arterial en pacientes adultos con choque cardiogénico refractario. Características clínicas y supervivencia en una serie de casos

Objetivo: describir las características clínicas y determinar probabilidad de supervivencia de los pacientes llevados a ECMO veno-arterial (ECMO VA) por indicación cardiaca en la Fundación Cardioinfantil (FCI-IC). Materiales y métodos: se realizó un análisis retrospectivo de una serie de 17 pacientes que fueron llevados a ECMO VA tras presentar choque cardiogénico refractario por múltiples causas: síndrome postcardiotomía (SPC), infarto agudo del miocardio, falla cardiaca crónica agudizada (FCCA), disfunción primaria de corazón trasplantado, entre otras. Se realizó descripción de las características demográficas y clínicas con medidas de tendencia central. Se realizó un análisis para determinar la probabilidad de sobrevivir a la terapia ECMO. Resultados: 12 pacientes fueron separados con vida del soporte con ECMO (71%) y 9 sobrevivieron al alta hospitalaria (53%). 50% de los fallecidos era mayor de 61 años y 100% de ellos tenía más de 50 años. Diabetes mellitus, hipertensión arterial, EPOC e hipertensión pulmonar fueron más frecuentes en los pacientes que murieron durante la ECMO VA. Las dos causas más frecuentes de choque cardiogénico fueron la FCCA y el SPC. La mediana de duración de la ECMO fue de 3 días. La probabilidad de supervivencia se redujo a 66% al quinto día de tratamiento. Conclusiones: la mortalidad intraterapia de la ECMO VA por indicación cardiaca en la FCI-IC es similar a la registrada a nivel mundial, observándose una disminución significativa de la probabilidad de sobrevida después del quinto día de tratamiento con soporte extracorpóreo.Objective: to describe the clinical characteristics and to determine the probability of survival of the patients treated with veno-arterial ECMO (VA ECMO) due to refractory cardiogenic indication in the Fundación Cardioinfantil (FCI-IC). Materials and methods: retrospective analysis of a series of 17 cases who required VA ECMO as a treatment for refractory cardiogenic shock secondary to multiple causes: postcardiotomy syndrome (PCS), acute myocardial infarction, acute decompensated heart failure (ADHF), primary graft dysfunction, among others. Demographic and characteristics were described with measures of central tendency. A survival analysis was made to establish the probability of these patients to be weaned off VA ECMO. Main results: 12 patients were succesfully weaned off VA ECMO (71%) and 9 survived to hospital discharge (53%). Median age of the deceased patients was 61 years. 100% of them were at least 50 years old. Diabetes mellitus, arterial hypertension, chronic pulmonary obstructive disease, and pulmonary hypertension were more frecuent in the non-survivors group of patients. PCS and ADHF were the two principal etiologies of cardiogenic shock requiring VA ECMO. Median duration of ECMO was 3 days. Non-survivors received more transfusions than survivors. Probability of survival was reduced to 66% after the fifth day of extracorporeal life support. Conclusions: VA ECMO mortality in FCI-IC is similar to that registered in most centers around the world, observing a significant reduction in survival probability after day 5 of extracorporeal life support

Evaluation of management of patients with chronic degenerative diseases in a primary health clinic

The efficacy of health actions, related to arterial hypertension and used as a strategy to decrease morbi-mortality due to cardiovascular diseases, in accordance with the "risk approach" and carried out in a Primary Health Care Clinic is assessed. These actions are based on the detection of arterial hypertension in the adult population attended at the Clinic and on the control of blood pressure levels in hypertensive individuals in which other known risk factors continue to be controlled, as well as on further treatment of eventual complications. Data relating to the 3,793 patients who were attended at least once by doctors of the adult sector of a training health-center located in S. Paulo county (Brazil) during the period from June 1990 to May 1991, inclusive, were evaluated. This evaluation was made according to each diagnosis undertaken as well as to the concentration of each type of consultation whether occasional, or follow-up. Of these 3,793 patients analysed, 839 presented arterial hypertension and/or diabetes, and were grouped into four categories: the exclusively hypertensive, the hipertensive with other associated chronic diseases (except diabetes), the diabetic and the diabetic with arterial hypertension. The results of this study brougth the following aspects to light: 1) The low coverage of hypertensive individuals and diabetics being attended by the health service when only the population attended by the health service is taken into consideration. 2) The incidence of patients diagnosed as hypertensive in occasional consultations who did not return to the health service for medical follow-up indicates the difficulties involved in attracting such individuals permanently. This loss is due to both the non-appearance of patients at the consultations programmed for their follow-up as well the lack of the follow-up program on the part of the health service. 3) With regard to these that fulfilled the follow-up program, the concentration of medical consultations and the concentration of absences presented satisfactory proportions, compatible with the proposal of quartely medical consultations. 4) The category of exclusively hypertensive individuals presented a lower concentration of attendance at consultations and a higher proportion of absences per consultation planned than did the others categories. Finally, the limitations of the actions based on the risk approach for the control of Chronic Degenerative Diseases are discussed.Avalia-se o desempenho de ações de saúde desenvolvidas em uma unidade básica de saúde, relativas ao controle da hipertensão arterial sistêmica (HAS) enquanto estratégia de redução de morbi-mortalidadc por doença cardiovascular baseada no "enfoque de risco". Estas ações estruturam-se a partir da detecção da hipertensão arterial na população adulta atendida no serviço e do controle dos níveis pressóricos nos indivíduos portadores de HAS, incluindo outros fatores de risco conhecidos, bem como tratamento de eventuais complicações. Analisaram-se 3.793 usuários que compareceram pelo menos uma vez à consulta médica no serviço de Assistência ao Adulto de um Centro de Saúde-Escola, do Município de São Paulo (Brasil), no período de 1º de junho de 1990 a 31 de maio de 1991. Para cada um dos usuários foram considerados os diagnósticos realizados, bem como a concentração de cada modalidade de consulta realizada (pronto-atendimento e consulta agendada). Destes, 839 eram portadores de hipertensão arterial e/ou diabete e foram agrupados em quatro categorias: os exclusivamente hipertensos, os hipertensos com outra doença crônica associada (exceto diabete), os diabéticos e os diabéticos com hipertensão arterial. Os resultados deste estudo mostraram: 1) baixa cobertura de indivíduos hipertensos e diabéticos em atendimento no serviço, quando se considera a população atendida pelo Centro de Saúde; 2) a existência de pacientes diagnosticados como hipertensos em consultas de pronto-atendimento, que não retornaram ao Centro de Saúde para seguimento médico programático, apontando para dificuldades na captação efetiva destes indivíduos. Esta "perda" deveu-se tanto a faltas dos pacientes às consultas agendadas para seu seguimento quanto ao não agendamento de consultas de seguimento por parte do serviço; 3) para os pacientes que aderiram ao seguimento, a concentração de consultas médicas e a concentração de faltas apresentaram números compatíveis com a proposta de agendamento trimestral; 4) a categoria dos exclusivamente hipertensos apresentou, quando comparada com as demais, menor concentração de consultas e maior proporção de faltas por consulta agendada. Discutem-se os limites das ações baseadas no "enfoque de risco" para controle de doenças crónico-degenerativas em população

Mechanisms of human telomerase reverse transcriptase (hTERT) regulation: clinical impacts in cancer

Background Limitless self-renewal is one of the hallmarks of cancer and is attained by telomere maintenance, essentially through telomerase (hTERT) activation. Transcriptional regulation of hTERT is believed to play a major role in telomerase activation in human cancers. Main body The dominant interest in telomerase results from its role in cancer. The role of telomeres and telomere maintenance mechanisms is well established as a major driving force in generating chromosomal and genomic instability. Cancer cells have acquired the ability to overcome their fate of senescence via telomere length maintenance mechanisms, mainly by telomerase activation. hTERT expression is up-regulated in tumors via multiple genetic and epigenetic mechanisms including hTERT amplifications, hTERT structural variants, hTERT promoter mutations and epigenetic modifications through hTERT promoter methylation. Genetic (hTERT promoter mutations) and epigenetic (hTERT promoter methylation and miRNAs) events were shown to have clinical implications in cancers that depend on hTERT activation. Knowing that telomeres are crucial for cellular self-renewal, the mechanisms responsible for telomere maintenance have a crucial role in cancer diseases and might be important oncological biomarkers. Thus, rather than quantifying TERT expression and its correlation with telomerase activation, the discovery and the assessment of the mechanisms responsible for TERT upregulation offers important information that may be used for diagnosis, prognosis, and treatment monitoring in oncology. Furthermore, a better understanding of these mechanisms may promote their translation into effective targeted cancer therapies. Conclusion Herein, we reviewed the underlying mechanisms of hTERT regulation, their role in oncogenesis, and the potential clinical applications in telomerase-dependent cancers.info:eu-repo/semantics/publishedVersio

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3–34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1–30.2), UTUC (n = 128) 1.14% (95% CI 0.77–1.52), renal cancer (n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32–2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03–1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer

ECMO veno-arterial en pacientes adultos con choque cardiogénico refractario. Características clínicas y supervivencia en una serie de casos

Objetivo: describir las características clínicas y determinar probabilidad de supervivencia de los pacientes llevados a ECMO veno-arterial (ECMO VA) por indicación cardiaca en la Fundación Cardioinfantil (FCI-IC). Materiales y métodos: se realizó un análisis retrospectivo de una serie de 17 pacientes que fueron llevados a ECMO VA tras presentar choque cardiogénico refractario por múltiples causas: síndrome postcardiotomía (SPC), infarto agudo del miocardio, falla cardiaca crónica agudizada (FCCA), disfunción primaria de corazón trasplantado, entre otras. Se realizó descripción de las características demográficas y clínicas con medidas de tendencia central. Se realizó un análisis para determinar la probabilidad de sobrevivir a la terapia ECMO. Resultados: 12 pacientes fueron separados con vida del soporte con ECMO (71%) y 9 sobrevivieron al alta hospitalaria (53%). 50% de los fallecidos era mayor de 61 años y 100% de ellos tenía más de 50 años. Diabetes mellitus, hipertensión arterial, EPOC e hipertensión pulmonar fueron más frecuentes en los pacientes que murieron durante la ECMO VA. Las dos causas más frecuentes de choque cardiogénico fueron la FCCA y el SPC. La mediana de duración de la ECMO fue de 3 días. La probabilidad de supervivencia se redujo a 66% al quinto día de tratamiento. Conclusiones: la mortalidad intraterapia de la ECMO VA por indicación cardiaca en la FCI-IC es similar a la registrada a nivel mundial, observándose una disminución significativa de la probabilidad de sobrevida después del quinto día de tratamiento con soporte extracorpóreo.Objective: to describe the clinical characteristics and to determine the probability of survival of the patients treated with veno-arterial ECMO (VA ECMO) due to refractory cardiogenic indication in the Fundación Cardioinfantil (FCI-IC). Materials and methods: retrospective analysis of a series of 17 cases who required VA ECMO as a treatment for refractory cardiogenic shock secondary to multiple causes: postcardiotomy syndrome (PCS), acute myocardial infarction, acute decompensated heart failure (ADHF), primary graft dysfunction, among others. Demographic and characteristics were described with measures of central tendency. A survival analysis was made to establish the probability of these patients to be weaned off VA ECMO. Main results: 12 patients were succesfully weaned off VA ECMO (71%) and 9 survived to hospital discharge (53%). Median age of the deceased patients was 61 years. 100% of them were at least 50 years old. Diabetes mellitus, arterial hypertension, chronic pulmonary obstructive disease, and pulmonary hypertension were more frecuent in the non-survivors group of patients. PCS and ADHF were the two principal etiologies of cardiogenic shock requiring VA ECMO. Median duration of ECMO was 3 days. Non-survivors received more transfusions than survivors. Probability of survival was reduced to 66% after the fifth day of extracorporeal life support. Conclusions: VA ECMO mortality in FCI-IC is similar to that registered in most centers around the world, observing a significant reduction in survival probability after day 5 of extracorporeal life support